ObjectiveTo investigate the in vivo anti-inflammatory effects of the triterpenoid saponin-enriched fraction Fr.B4 from the She medicine Clematis florida (C. florida) in a rat model of phenol-induced cervicitis and to preliminarily explore its potential mechanisms of action. MethodsThirty 6–8-week-old female SPF-grade SD rats were randomly assigned to three groups: control, cervicitis model, and C. florida treatment group, with 10 rats in each group. The model and C. florida treatment groups were induced with cervicitis by vaginal injection of 25% phenol gel (once every 2 d, for a total of three injections), and the vulva and cervix were examined to assess the effectiveness of model establishment. After successful modeling, the C. florida treatment group was administered Fr.B4 at 290 mg/kg daily by gavage (dissolved in normal saline), whereas the model group received an equal volume of normal saline; both treatments continued for 2 weeks. The control group received no modeling procedure and was administered normal saline for 2 weeks. After the last intervention, fresh feces and urine samples were collected from all rats. The rats were euthanized after anesthesia with 40 mg/kg Zoletil 50, and the serum and cervical tissue samples were harvested. ELISA was used to measure the levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-6 (IL-6) in rat serum and cervical tissue. Hematoxylin and eosin (HE) staining was performed to observe the pathological changes in cervical tissue. Liquid chromatography-mass spectrometry was employed to analyze differential metabolites in feces and urine, followed by Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment and core metabolite analysis. 16S rDNA sequencing was used to assess the gut microbiota structure and diversity in each group. Statistical analysis was conducted using GraphPad Prism 9.0. ResultsCompared with the control group, rats in the model group exhibited cervical redness, swelling, and erosion, with significant increases in TNF-α, IL-1β, and IL-6 levels in both serum and cervical tissue (P<0.05 or P<0.01). Pathological examination of cervical tissue showed thickening of the squamous epithelium, infiltration of inflammatory cells, and edema. Compared with the model group, rats with C. florida treatment showed marked alleviation of cervicitis symptoms, with significantly reduced levels of pro-inflammatory cytokines in serum and cervical tissue (P<0.05 or P<0.01). Cervical tissue edema was alleviated, inflammatory cells were reduced, and squamous epithelium thickening was ameliorated. Metabolomics analysis revealed 346 and 564 differential metabolites in the feces and urine between the model and control groups, respectively. After treatment with Fr.B4, 236 and 451 metabolites in the feces and urine showed significant shifts toward control levels, involving pathways including cyclic adenosine monophosphate (cAMP) signaling, AMP-activated protein kinase (AMPK) signaling, and glutathione metabolism. Anti-inflammatory metabolites like boswellic acid and oleanolic acid were increased (P<0.01 or P<0.001). Gut microbiota analysis showed dysbiosis in the model group, with an imbalance in the Firmicutes/Bacteroidetes ratio. The Fr.B4 treatment remodeled the gut microbiota. The α-diversity of microbiota shifted toward that of the control group. Specific bacterial genera were found to correlate significantly with metabolites (P<0.05 or P<0.01). ConclusionThe triterpenoid saponin-enriched fraction Fr.B4 from She medicine C. florida may exert anti-cervicitis effects by reducing pro-inflammatory cytokine levels, modulating the gut microbiota balance, and remodeling metabolism.

Objectives:To investigate the impact of the Micra AV leadless pacemaker on cardiac function.Methods:A total of 76 patients who received the implantation of Micra AV leadless pacemaker due to sick sinus syndrome or atrioventricular block at Ruijin Hospital,Shanghai Jiao Tong University School of Medicine from September 2022 to April 2023 were included in this study.Among them,26 patients(34.2%)had sick sinus syndrome,and 50 patients(65.8%)had atrioventricular block.The patients were followed up for 1 year postoperatively.Cardiac function was evaluated by echocardiography,and the parameters of the pacemaker were collected through the outpatient clinic programming system.Results:After a follow-up of 120(87,181)days,compared with the preoperative state,the left ventricular ejection fraction(LVEF)decreased postoperatively([66.6±5.6]%vs.[63.8±5.2]%,P<0.001),and the cardiac output increased[(4.3±1.2)L/min vs.(5.3±1.5)L/min,P<0.001].There were no statistically significant differences in various cardiac function indexes of patients with sick sinus syndrome between the postoperative and preoperative states(all P>0.05).Compared with the preoperative state,in patients with atrioventricular block,the LVEF decreased postoperatively([67.0±5.1]%vs.[63.4±4.4]%,P<0.001),the cardiac output increased([4.2±1.1]L/min vs.[5.2±1.2]L/min,P<0.001),and the left ventricular end-diastolic diameter decreased[(49.9±5.4)mm vs.(48.6±5.0)mm,P=0.044].Firth's logistic regression analysis indicated that the preoperative LVEF(for every 1%increase,OR=1.56,95%CI:1.12-2.17,P=0.001),stroke volume(for every 1 ml increase,OR=1.15,95%CI:1.04-1.28,P=0.001),body mass index(for every 1 kg/m2 increase,OR=1.49,95%CI:1.02-2.17,P=0.020),and hypertension(OR=12.71,95%CI:1.11-145.13,P=0.039)were independent risk factors for the decrease in LVEF after surgery in patients with atrioventricular block.After the implantation of the MciraTM AV leadless pacemaker,the overall atrioventricular synchrony rate was 81.2%(68.8%,89.0%).The atrioventricular synchrony rates of patients with sick sinus syndrome and those with atrioventricular block were 70.6%(59.5%,83.4%)and 82.4%(74.2%,89.3%)respectively(P<0.05).Firth's logistic regression analysis indicated that sick sinus syndrome(OR=0.26,95%CI:0.07-0.89,P=0.029)and preoperative LVEF(for every 1%increase,OR=1.18,95%CI:1.03-1.35,P=0.015)were independent predictive factors for the atrioventricular synchrony rate>80%.Conclusions:There are differences in the impacts of the Micra AV leadless pacemaker on the LVEF and atrioventricular synchrony rate between patients with sick sinus syndrome and those with atrioventricular block.The preoperative LVEF,stroke volume,body mass index,and hypertension have independent predictive effects on the decrease in postoperative LVEF in patients with atrioventricular block.Sick sinus syndrome and preoperative LVEF are independent predictive factors for the atrioventricular synchrony rate>80%after surgery.

Objective To explore the possible mechanism underlying the role of forkhead box A1 circular RNA(circ-FAT1)regulating pericyte pyroptosis in diabetic retinopathy(DR).Methods The experiment was divided into two parts.Firstly,thirty male C57BL/6J mice(totaling 60 eyes)were randomly divided into normal,DR and circFAT1 overex-pression groups,with 10 mice in each group.Fasting plasma glucose(FPG)was detected by a glucometer.The serum lev-els of total cholesterol(TC)and triacylglycerol(TG)were measured by enzyme-linked immunosorbent assay(ELISA)kits.Hematoxylin and eosin(HE)staining was used to examine the pathological structure of mouse retina.Reverse tran-scription-quantitative polymerase chain reaction(RT-qPCR)was used to detect the mRNA expression of circFAT1 in retinal tissues.The relative protein expression levels of NOD-like receptor protein 3(NLRP3),Caspase-1 and porin D(GSDMD)in the retina of mice were detected by Western blot.Secondly,retinal perivascular cells were extracted from 5 C57BL/6J mice(totaling 10 eyes)and divided into control,high glucose and circFAT1 overexpression+high glucose groups.The protein expression levels of NLRP3,Caspase-1 and GSDMD in pericytes were detected by Western blot.ELISA kits were used to measure the content of interleukin-18(IL-18)and interleukin-1β(IL-1β)in pericytes.Results(1)Compared with those in the normal group,the levels of FPG,serum TC and TG were increased while the relative expression level of circFAT1 mRNAs in the retinal tissue was decreased in the DR group(all P＜0.05).Compared with the DR group,the circ-FAT1 overexpression group showed decreased levels of FPG,serum TC and TG(all P＜0.05),and increased relative ex-pression levels of circFAT1 mRNAs in the retinal tissue(P＜0.05).The relative expression levels of NLRP3,Caspase-1 and GSDMD proteins in the retinal tissue of the DR Group were higher than those in the normal group(all P＜0.05).The rela-tive expression levels of NLRP3,Caspase-1 and GSDMD proteins in the retinal tissue of the circFAT1 overexpression group were lower than those in the DR group(all P＜0.05).(2)Compared with those in the control group,the relative expres-sion levels of NLRP3,Caspase-1,and GSDMD proteins and the content of IL-18 and IL-1 β in the pericyte of the high glucose group were increased(all P＜0.05).The relative expression of NLRP3,Caspase-1 and GSDMD proteins and the content of IL-18 and IL-1 β in the pericyte of the circFAT1 overexpression+high glucose group were lower than those in the high glu-cose group(all P＜0.05).Conclusion Overexpression of circFAT1 can improve DR by inhibiting pericyte pyroptosis.

Objective:To investigate the 10-year incidence of reproductive system malignancies and their associated risk factors among overweight and obese women with different metabolic phenotypes aged 40 years and older in Guiyang City.Methods:A total of 6 444 female residents in Yunyan District, Guiyang City were included from the 2011 " Epidemiological Study on the Risk of Malignancy in Chinese Patients with Type 2 Diabetes Mellitus(REACTION)". Based on body mass index(BMI) and the presence or absence of metabolic syndrome(MetS), participants were categorized into four groups: metabolically healthy normal weight(MHNW, n=2 373), metabolically unhealthy normal weight(MUNW, n=1 098), metabolically healthy overweight/obese(MHO, n=2 229), and metabolically unhealthy overweight/obese(MUO, n=744). Baseline data were collected, and participants were followed up for 10 years to document the incidence of female reproductive system malignancies, including breast cancer, ovarian cancer, cervical cancer, and endometrial cancer. Logistic regression models were used to evaluate the association between metabolic phenotype and the 10-year risk of developing reproductive system malignancies. Results:Over a mean follow-up period of (9.89±0.77) years, the overall incidence of reproductive system malignancies was 1.15%(74/6, 444). Baseline characteristics such as age, BMI, high-density lipoprotein-cholesterol(HDL-C), and triglycerides(TG) differed significantly among the groups( P<0.05). The cumulative incidence of reproductive system malignancies in each group was: MHNW 0.93%(22/2 373), MUNW 0.73%(8/1 098), MHO 1.57%(35/2 229), and MUO 1.21%(9/744). There were no statistically significant differences in incidence across the four groups( P>0.05). However, multivariable logistic regression analysis revealed that, compared with the MHNW group, the adjusted HR (95% CI) were: MUNW 0.787(0.349-1.774, P>0.05), MHO 4.835(1.708-13.688, P<0.05), and MUO 3.719(1.144-12.089, P<0.05). Conclusion:Overweight and obesity are significant risk factors for reproductive system malignancies in women aged 40 and above. The presence of metabolic abnormalities in overweight or obese women further increases the risk of developing such malignancies.

Objective:To observe the clinical effect of comprehensive reconstruction of grades Ⅰ-Ⅱ thumb and finger defects with hallux osteo-onychocutaneous flaps of great toe.Methods:This is a retrospective study. From June 2020 to December 2023, comprehensive reconstruction surgery for Grade Ⅰ-Ⅱ digital defect were performed with hallux osteo-onychocutaneous flaps of great toe for 3 thumbs and 7 fingers in 9 patients in the Department of Hand and Microsurgery of Baoji Third Hospital. Causes of digital injury were: 4 of machine crush, 3 of electric saw cut, 1 of door crush, and 1 of electrical burn. There were 6 grade I digital defects (beyond the nail root) and 4 grade Ⅱ defects (last segment of digit). The defects of the digits were reconstructed by taking references of the shape and structure of the contralateral normal thumbs and fingers. Then the hallux osteo-onychocutaneous flaps of great toe were designed and harvested accordingly from the left and right great toes. Donor sites were covered by skin grafting or local dressing change. One patient was treated in emergency surgery, 6 in sub-emergency surgery and 2 in elective surgery. Integrated perioperative patient management was provided to all of the patients. Postoperative follow-ups were conducted through the visit of outpatient clinic, telephone calls or WeChat interviews. Flap survival, appearance and sensation recovery were evaluated according to the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association.Results:Vascular insufficiency of 1 digit occurred in surgery, and relieved by local treatment with lidocaine and warm saline. All 10 digits successfully survived, and all donor sites healed spontaneously. The postoperative follow-up period was 10 to 30 months, with an average of 18 months. One transferred nail was found in poor appearance (not flat), the rest of the reconstructed digits were good in appearance and function. The nail, finger print and fine sensation (TPD 5~8 mm), as well as digital flexion, extension, grasping and opposition of the reconstructed digits were all good. According to the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association, at the last follow-up visit, 5 digits were in excellent, 4 in good and 1 in fair.Conclusion:The comprehensive reconstruction of grades Ⅰ-Ⅱ digital defects with hallux osteo-onychocutaneous flap of great toe is an ideal surgical technique that can reconstruct the nail, finger print and sensation of a digit, with good postoperative function as well as an aesthetic and realistic appearance.

Objective:To investigate the levels of serum heat shock protein 27 (HSP27) in patients with multiple myeloma (MM) and its relationship with disease diagnosis, treatment, and prognosis.Method:Retrospective cohort study. We select 85 newly diagnosed MM patients from the Second Affiliated Hospital of Fujian Medical University from December 1, 2021 to June 30, 2023, including 43 males and 42 females, aged 60 (48, 81) years. Their serum HSP27 levels were measured at the time of initial diagnosis, and 100 healthy individuals who underwent physical examinations during the same period were recruited as controls. The correlation between serum HSP27 levels in MM patients and common clinical indicators such as gender, age, hemoglobin (Hb), serum creatinine (Cr), calcium (Ca), lactate dehydrogenase (LDH), β2-microglobulin levels (β2-MG), and bone marrow plasma cell ratio were analyzed; grouping 85 MM patients according to disease types and stages, and the differences in HSP27 levels before and after treatment in different MM classifications, stages, and treatments were compared; using receiver operating characteristic (ROC) curves to obtain the predictive value of initial HSP27 levels for remission in MM patients after standardized treatment, and calculating the optimal critical value. MM patients were divided into a high HSP27 group of 37 cases and a low HSP27 group of 48 cases based on the cutoff value, and Kaplan-Meier was used to compare the survival differences between the two groups.Result:The serum HSP27 levels in newly diagnosed MM patients were higher than those in healthy individuals [(281.33±27.69) pg/ml, (52.11±8.12) pg/ml, t=73.7, P0.001]. There was no correlation between HSP27 levels and patients' MM classification, gender, age, Hb serum Cr, Ca, LDH, and the proportion of bone marrow plasma cells, but positively correlated with β2-MG levels ( r=0.703, P0.05). There are significant differences in HSP27 levels at different stages of MM and before and after treatment; ROC curve results showed that serum HSP27 levels have certain predictive value for whether MM patients can achieve remission after treatment: sensitivity of 75.0%, specificity of 63.8%, and area under the curve of 0.720; the optimal cut-off value is 281.19 pg/ml. The survival time of the low HSP27 level group is longer than that of the high level group. Conclusion:Serum HSP27 is highly expressed in MM, and is correlated with the disease condition, treatment, and prognosis of MM.

A case report of adult skeletal class Ⅲ patient with high angle open bite is presented in this article.The patient underwent extraction of bilateral mandibular first molars and straightening the third molars,open bite was resolved,normal over bite,over jet and good occlusion were established.

Objective:To explore the mediating effect of accompanied childbirth experience among spouses of primipara on dynamic adjustment after marriage and paternal role adaptation, with the aim of providing reference for further improving accompanying childbirth services.Methods:Spouses of primipara who participated in accompanying childbirth at Nanjing Drum Tower Hospital Group Suqian Hospital from January 2023 to June 2024 were selected as the research subjects through convenience sampling. The general information questionnaire, the Chinese version of Dynamic Adjustment Scale, the Parents' Experiences of Childbirth and the Newborn Father's Role Adaptation Questionnaire were used to conduct a cross-sectional survey, and establish the intermediary model between the dynamic adjustment after marriage and the paternal role adaptation.Results:A total of 244 spouses of primipara were included, with an age of (28.86 ± 5.77) years. The score for dynamic adjustment in spouses of primipara was (110.82 ± 16.33) points, the score for experiences of childbirth was (124.27 ± 13.89) points, and the score for paternal role adaptation was (71.66 ± 9.22) points. The accompanied childbirth experience among spouses of primipara was positively correlated with the dynamic adjustment after marriage and the paternal role adaptation ( r=0.197, 0.511, both P<0.01). The dynamic adjustment after marriage was positively correlated with the paternal role adaptation ( r=0.403, P<0.01). The accompanied childbirth experience among spouses had a partial mediating effect between the dynamic adjustment after marriage and the parental role adaptation, which the mediating effect was 0.182, accounting for 32.79% of the total effect. Conclusions:The dynamic adjustment after marriage can directly predict the paternal role adaptation, and the experience of accompanying childbirth has a partial mediating effect between the two. The role adaptation level of the spouses of the primiparas should be improved by further improving the delivery service to meet the needs of the primiparas and their spouses.

Objective Innovatively establish an information management model for the entire lifecycle of equipment ap-plicable to disease prevention and control centers.Methods An in-depth analysis of the current situation of equipment manage-ment and existing problems,relying on the laboratory information management system,combined with the theory of high-quality full-life-cycle management,incorporating advanced information technology management,and adoption of targeted measures to pro-mote the solution of problems one by one.Results Implement and improve the whole life cycle information management node,set up an equipment management committee,innovate the use of new equipment identification plates,develop a mobile platform client,and realize management data visualization.Conclusion The Informatisation management mode of the whole life cycle of equipment with the Center for Disease Control and Prevention characteristics.It realizes the whole life cycle,dynamic and Informatisation man-agement of equipment from demand,acceptance,use,maintenance,measurement,deactivation and scrapping.It strengthens the process management and quality control of equipment and serves to improve disease prevention and control capabilities.

Objective To systematically evaluate the clinical effects of remote ischaemic preconditioning (RIPC) in elective vascular surgery. Methods Electronic searches were conducted in The Cochrane Library, PubMed, EMbase, Web of Science, CNKI, Wanfang Data, VIP Database, and CBM. Relevant randomized controlled trials (RCTs) were screened according to inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.3 software, and the risk of bias was assessed using the Cochrane risk of bias tool. Results A total of 15 studies involving 1 382 patients were included. The meta-analysis results showed no statistically significant difference between RIPC and non-RIPC groups in reducing perioperative mortality in elective vascular surgery (P>0.05). There were also no statistically significant differences between the two groups of vascular surgery patients regarding the incidence of myocardial infarction, renal injury, postoperative stroke, postoperative length of hospital stay, duration of surgery or total anesthesia time, or the incidence of limb injury, arrhythmia, heart failure, and pneumonia (P>0.05). Conclusion For patients undergoing elective vascular surgery, there are no significant differences between RIPC and non-RIPC in terms of perioperative mortality and other clinical endpoint outcomes.